Genitourinary Syndrome of Menopause or
Vulvo-vaginal atrophy
Vaginal atrophy is the thinning, dryness, and inflammation of the vaginal walls. which can occur when your body has less estrogen.
For many women, vaginal atrophy not only makes intercourse painful but also causes distressing urinary symptoms. Because the condition produces both vaginal and urinary symptoms, doctors use the term "genitourinary syndrome of menopause (GSM)" to describe vaginal atrophy and its accompanying symptoms.
Menopause is the natural cessation of menstruation in women. It occurs when the ovaries stop producing eggs, which decreases the levels of estrogen and progesterone in the body.
The decline in hormone levels after menopause has a negative effect on the genital and urinary tract., resulting in a variety of symptoms. GSM affects women's quality of life and has become a major health problem.
Vaginal dryness and dyspareunia are the most common symptoms and can be particularly distressing for women who want to maintain an active sex life.
Vaginal dryness can also cause irritation and itching, which can lead to a decrease in quality of life.
GSM is due to decreased hormone levels after menopause.
Estrogen and progesterone levels are critical for the health of a woman's genital and urinary tract.
Decreased levels can cause a decrease in the elasticity and hydration of vaginal tissues, as well as a decrease in vaginal lubrication.
This can lead to decreased sexual satisfaction and increased risk of urinary tract infections.
Symptoms of GSM may vary from woman to woman, but the most common include:
- Vaginal dryness.
- Vaginal burning.
- Vaginal discharge.
- Genital itching.
- Burning sensation when urinating.
- Urgency to urinate.
- Need to urinate frequently.
- Recurrent urinary tract infections.
- Urinary incontinence
- Light bleeding after sexual intercourse.
- Discomfort during sexual intercourse (dyspareunia).
- Less vaginal lubrication during sexual activity.
- Narrowing and shortening of the vaginal canal.
Genitourinary syndrome of menopause is caused by a decrease in estrogen production. With less estrogen, vaginal tissues become thinner, drier, less elastic, and more fragile.
A decrease in estrogen levels may occur in these situations:
- After menopause.
- During the years before menopause (perimenopause).
- After surgical removal of both ovaries (surgical menopause).
- During breastfeeding.
- While taking medications that can affect estrogen levels, such as some birth control pills.
- After pelvic radiation therapy for cancer.
- After chemotherapy for cancer.
- As a side effect of hormonal treatment for breast cancer.
Signs and symptoms of menopausal genitourinary syndrome may begin to bother you in the years before menopause or may not become a problem until several years after menopause begins.
Although the condition is common, not all menopausal women will develop genitourinary syndrome of menopause. Regular sexual activity, with or without a partner, can help prevent genitourinary syndrome of menopause because it increases blood circulation in the vagina, which helps keep vaginal tissues healthy.
Certain factors may contribute to genitourinary syndrome of menopause, such as:
- Smoking. Smoking affects blood circulation and can decrease the flow of blood and oxygen to the vagina and other nearby areas. Smoking also reduces the effects of natural estrogens in the body.
- Absence of vaginal births. Researchers have observed that women who have never given birth vaginally are more likely to develop symptoms of genitourinary syndrome of menopause than women who have had vaginal births.
- Absence of sexual activity. Sexual activity, with or without a partner, increases blood flow and makes vaginal tissues more elastic.
There are simple and effective treatments for GSM. Reduced estrogen levels cause changes in your body, but this doesn't mean you have to live with the discomfort of GSM.
Treatment for GCS focuses on restoring hormonal levels in the body.
Hormonal treatments, such as hormone replacement therapy (HRT), can be effective in relieving the symptoms of GSM.
HRT involves the use of hormones to replace hormone levels that decline after menopause.
Other treatment options for GSM include vaginal creams and lubricants, which can help relieve vaginal dryness and dyspareunia.
Lubricants can be used during sexual intercourse to improve vaginal lubrication, while creams can be applied daily to maintain vaginal tissue hydration.
If these options do not relieve symptoms, other treatments may be used:
– Topical estrogen
Vaginal estrogen has the advantage of being effective at lower doses and limiting overall estrogen exposure because less estrogen reaches the bloodstream. It may also provide better direct symptom relief compared to orally administered estrogen.
Vaginal estrogen therapy comes in several forms. Since they all seem to work equally well, you and your doctor can decide which is best for you.
– Ospemifene
When taken daily, this pill can help relieve painful sexual symptoms in women with moderate to severe genitourinary syndrome of menopause.
– Prasterone (Intrarosa)
These vaginal suppositories deliver the hormone DHEA directly to the vagina to help relieve pain during sex. DHEA is a hormone that helps the body produce other hormones, including estrogen. Prasterone is used nightly for moderate to severe vaginal atrophy.
– Systemic estrogen therapy
If vaginal dryness is associated with other menopausal symptoms, such as moderate or severe hot flashes, your doctor may suggest estrogen pills, patches, or gel, or a higher dose of an estrogen ring.
– Vaginal dilators
You can use vaginal dilators as a non-hormonal treatment option. Vaginal dilators can also be used alongside estrogen therapy. These devices stimulate and stretch the vaginal muscles to reverse vaginal narrowing.
If painful sex is a concern, vaginal dilators can stretch the vagina to relieve vaginal discomfort.
– Regenerative treatments: Energy-based devices: Laser, biocompatible material, PRP (platelet-rich plasma)
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